Genomic Nursing Competency Implementation Strategic Plan 2014

46 Pages·2014·0.26 MB·English

Genomic Nursing Competency Implementation
Strategic Plan
2014-2020

A Report by the Genomic Nursing Competency Strategic
Implementation Plan Panel

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Forward

Why Genomics?
Much progress has been made in understanding the relevancy of genomic science to
healthcare and the potential value for translation of genomics for improved outcomes of patient
care. Advancing genomic technology and knowledge influences the entire healthcare continuum
and impacts all healthcare providers. Nurses remain the largest segment of the health care
provider community in the United States with more than 4.1 million licensed registered nurses of
which 82% are actively practicing1. Nurses, both in academic and practice settings, are
beginning to recognize the importance of genomics for education, policy, research, and practice.
However, considerable work remains both for individuals and healthcare systems to be able to
appropriately and effectively use genomic information in care. Critical to translation is a
genomically competent workforce. Current evidence indicates that the healthcare workforce
continues to have a lack in genomic knowledge and competency limiting their ability to integrate
the technology and information effectively2. Genomic knowledge deficits translate to a decline
in access to safe, cost-effective, personalized patient care which provides the justification for
updating the Genomics Strategic Implementation Plan.

The Value of Genomic Competency Implementation Strategic Planning
Strategic planning is used to set priorities, focus energy and resources, strengthen progress
made toward common goals, establish agreement around intended outcomes/results, and assess
and adjust actions in response to a changing environment. Effective strategic planning
articulates not only where to go, but also what to do, and the actions needed to make progress, as
well as what constitutes success. Progress over the last decade has enabled nurses to assume
leadership for defining genomic competencies3,4, to integrate genomics into education
accreditation standards5, to consider the ethical implications of genomic information for policy6,
and to incorporate genomics into practice7. The desire for continued transformation of nursing
genomic competency in academics, practice, regulatory, healthcare system infrastructure,
healthcare provider collaborations, and improved consumer outcomes of care necessitated a
review of the initial 2006-2011 Genetics and Genomics Strategic Implementation Plan.
Sustainability, building on what had already been achieved from the prior strategic plan,
provided a foundation from which to initiate discussion about continued advancement. This
systematic process of envisioning a desired future that includes genomic healthcare with
consideration of steps required to realize that vision involved identifying targeted opportunities,
exploring potential strategies,and consideration of potential partners/collaborators. The value of
this new genomic comptetency implementation strategic plan is that it continues to define
methods to expand the capacity to translate a vision for the future of genomics for nursing
practice into broadly defined goals or objectives and a sequence of strategies to achieve them.
Sharing the strategic plan with stakeholders makes the direction and focus of efforts more
transparent and visible to those who might contribute to success. Together these options provide
a pathway for nurses and potential collaborators to follow so as to assure successful translation
of genomics science resulting in improved outcomes of patient care.

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Methods

The purpose of this strategic planning initiative was to build on progress made with the 2006-
2011 Strategic Plan by creating the next 6 year strategic plan that addresses infrastructure needs,
nursing research, education and professional practice/service aimed at continued advancement of
nursing genomic competency.

Panel Representation
A Genomic Nursing Competency Strategic Implementation Plan Panel (Appendix A) was
assembled to provide input into the content of the Strategic Plan. The Panel was coordinated by
the co-chairs of the National Institutes of Health Genetic/Genomic Nursing Competency
Initiative. Panel members were selected by the coordinators based on their expertise in nursing
research, genomics, nursing education, health systems outcome measurements, nursing
leadership, nursing administration, pharmacy, and medicine. Panelists included representatives
from various different healthcare disciplines as well as different Department of Health and
Human Services agencies including the National Institutes of Health and the Health Resources
and Services Administration.

Key Stakeholder Testimony
To be sure that the Strategic Plan sufficiently considered issues relevant to specific groups
and/or issues of concern, key stakeholder testimony (Appendix B) was sought from critical
groups including nursing education, healthcare consumers, medicine, and nursing regulation.

In Person Meeting
The Genomic Nursing Competency Strategic Implementation Plan Panel was convened for a
single one day in-person meeting on September 16, 2013 (see Appendix C for agenda). The
meeting began with an overview and outcomes from the prior Strategic Plan as well as ongoing
obstacles and challenges. Testimony from four Key Stakeholders groups (Appendix B) nursing
education, healthcare consumers, medicine, and nursing regulation was heard by the panel. This
was followed by Panel discussion of the Mission and Vision statements for the strategic plan.
The majority of the meeting time was spent focusing on the Strategic Plan Domains and
corresponding strategic objectives including discussion about targeted opportunities, strategies to
be considered, partners and collaborators to be engaged. The last major discussion point was
identification of pathways of influence.
The in-person Strategic Planning Meeting was followed by compiling all of the components
and content obtained during the discussion for review and refinement by the Panel. A modified
Delphi Survey of the draft Strategic Plan (Appendix D) was developed and disseminated to Panel
members for online complention using Survey Monkey. The Survey assessed mission, vision
and objective statements for modification. Additionally, strategies were evaluated for level of
importance, timing, and identification of potential collaborative partnerships.
Survey results specific to language modifications were integrated into the draft Strategic
Plan. No proposed modifications were unclear or contentious so consensus by the panel was not
required. Frequencies were calculated on descriptive data related to importance and timing and
incorporated into the Strategic Plan. This was followed by distribution of the draft Strategic Plan
to panel members for approval and finalization.
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Genomic Nursing Competency Implementation Strategic Plan

Mission/Vision Statements

Mission Statement: Basic competency in genetics and genomics for all nurses.

Vision Statement: Improve the health of the public with awareness and utilization of
genomics by nurses.

Strategic Plan Domains
Infrastructure
Outcome Objective: Provide the structure, direction, and focus for all efforts
identified under each of the strategic plan domains as well as provide centralized
coordination of activities to operationalize this strategic plan.
Priority
(Target
Strategy Collaborative Partnership
Completion
Years)
Establish Method for Integrating a 2012-2013 MINC Participating 1 (0-2)
New Competency into practice Champions
(MINC) toolkit and corresponding
monograph (Manual of Procedures).
American Association of Colleges of 2 (0-2)
Nursing (AACN), National Coalition for
Create additional genomic educational
Health Professional Education in
resources (including expansion of
Genetics (NCHPEG), March of Dimes
existing resources such as the Global
(MOD), Health Resources and Services
Genetics and Genomics Community
Administration (HRSA), American
(G3C), Gene Splash, and workshops
Hospitals Association (AHA), American
targeted for the older learner).
Pharmacists Association (APhA),
National Library of Medicine (NLM)
University of Pittsburg; University of 3 (0-2)
Iowa; Clemson; University of
Washington, University of Cincinnati,
University of Michigan, University of
Explore schools that could be
Pennsylvania, Duke, University of
positioned to respond to HRSA
California, Los Angeles (UCLA), Johns
Interprofessional Education (IPE)
Hopkins University, University of
funding.
California, San Francisco (UCSF),
University of California, San Diego
(UCSD), University of Utah, Columbia
University, University of Maryland
Explore federal opportunities for MOD, HRSA, National Institutes of 4 (0-2)
genomic expert development (i.e., Health (NIH) training grants
HRSA Faculty Loan Program).
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Explore federal methodologies and HRSA, National Institutes of Nursing 5 (0-2)
opportunities for hiring trainees (i.e., Research (NINR), National Human
Intergovernmental Personnel Action Genome Research Institute (NHGRI),
(IPA); post docs; joint trainee NIH
fellowships across NIH Institutes and
agencies).
Focus on development of tools to EPIC, Cerner, eMERGE grantees, MINC 6 (0-5)
facilitate genomic practice integration Champions. Start pursuing 0-2 years but
(i.e., Electronic Health Record (EHR), expected to take a longer interval for
point of care decision support, family completion.
history inclusion in discharge
summaries).
Develop a Center that serves as the Existing staff at NINR, NHGRI or 7 (0-5)
main coordinating infrastructure for HRSA should be designated to
strategic plan implementation. coordinate.

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Workforce Competency
Outcome Objective: All registered nurses will have a foundation of knowledge in basic human
genetics and genomics and current applications to nursing practice (i.e., encompasses academic,
research, and clinical competency efforts).
Priority
(Target
Strategy Collaborative Partnership
Completion
Years)
National campaign education effort ANA, AACN, National League for 1 (0-2)
(i.e., American Nurses Association Nursing (NLN), International Society of
(ANA) methodologies, inclusive of Nurses in Genetics (ISONG), Sigma
diverse professional nursing Theta Tau International (STTI),
organizations): American Academy of Nurses (AAN)
• Improve genomic awareness
• Provide sufficient knowledge
and skill building to attain
clinical translation
• Priority targeted education
audiences
i. Advanced Practice
Registered Nurses
(APRN) including Doctor
of Nursing Practice
(DNP)
ii. Associate Degree in
Nursing (AND)
iii. ADN to Bachelors
Degree in Nursing (BSN)
iv. Administrators
v. Leadership
vi. Deans
vii. Second degree students
viii. Faculty
ix. Interprofessional
Establish a resource list of all ISONG, AACN, NLN, ANA, STTI 2 (0-2)
available genomic certificate or
academic programs in genomics for
posting on genome.gov.
Provide resources to achieve ISONG, National Society of Genetic 3 (0-2)
competency for family history data Counselors (NSGC), American College
collection, interpretation, and of Medical Genetics (ACMG), MOD,
knowledge of criteria for referral. NCHPEG.
Marketing of resources (i.e. American Organization of Nurse 4 (0-2)
Genetics/Genomics Competency Executives (AONE), ANA, Competency
Center for Education (G2C2) and endorsees
(G3C) to professional nursing
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organizations.
Establish an interprofessional To be determined. 5 (3-5)
genomic practice and/or academic
initiative modeled after MINC.
Assess the value of post master’s AACN, Geisinger, Kaiser 6 (3-5)
genomic certificate programs to
determine if expansion of this
strategy is warranted.
Create a network of genomic STTI, American Society of Human 7 (3-5)
researchers to mentor PhD and DNP Genetics (ASHG)
students.
Establish additional opportunities for Intersociety Coordinating Committee 8 (0-5)
genomic continuing education for (ISCC)
the practicing provider (i.e., G3C
cases).
Create a toolkit to facilitate genomics NINR, Genomic Nursing Science 9 (3-5)
nursing research. Blueprint Advisory Panel
Establish model genomic nursing All major Colleges of Nursing including 10 (3-5)
curricula for all levels of academic online universities (i.e. Phoenix).
preparation.

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Regulation
Outcome Objective: Genomics is included practice content on assessments of quality healthcare
evaluation (i.e. workforce, healthcare institution, academic).
Priority
(Target
Strategy Collaborative Partnership
Completion
Years)
ISONG, AACN 1 (0-5)
Influence the Essential revisions
through AACN to include genomics.
Establish Outcome Indicators for the Greco, Seibert, Tinley and/or 2 (0-2)
Essential Genetic and Genomic Competency sub-committee
Competencies for Nurses with
Graduate Degrees.
Assess The Joint Commission The Joint Commission, ISONG, ACMG, 3 (0-2)
standards for inclusion of genomics; NSGC, AAN, AACN, NLNAC, CCNE
target JCO leadership to enhance
genomic content in these accreditation
standards and reviews (nursing
advisory board).
Assess Accountable Care ISONG, ACMG, NSGC 4 (3-5)
Organizations (ACOs) standards for
inclusion of genomics; target the
ACOs leadership to enhance genomic
content in these accreditation
standards and reviews.
Assess outcomes of Commission of AACN, STTI, HRSA 5 (3-5)
Collegiate Nursing Education (CCNE)
accreditation changes since
incorporating genomics in the
Baccalaureate and Master’s Essentials.
-Faculty survey (including efforts to
include Adjunct faculty)
-Student survey
-Assess CCNE criteria for reviewing
genomics in accreditation evaluations
-Assess curriculum for evidence of
genomic content.
Assess National Quality Forum AAN, ANA, STTI, ISONG 6 (0-5)
(NQF) standards for inclusion of
genomics; target NQF leadership to
enhance genomic content in these
accreditation standards.

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Clinical Service Delivery Infrastructure
Outcome Objective: Provide the structure, policy, resources, and interprofessional partners
necessary for the successful integration of genomics into healthcare delivery.
Priority
(Target
Strategy Collaborative Partnership
Completion
Years)
Clinical structure, policies and/or 2012-2013 MINC Participating 1 (0-2)
guidelines (i.e., models/templates) Champions
• Family history and referral.
• Role of the nurse and referral.
• Privacy and confidentiality.
• Informed consent for germline
single gene testing,
pharmacogenomics testing,
somatic (tumor) testing).
• Ethical decision making support
and resource algorithm process.
Seek genomic education and diffusion Robert Wood Johnson Foundation 2 (0-5)
sustainability funding (i.e., MINC, (RWJ), Kellogg foundation
interprofessional partners).
Incentives for resource support (i.e., To be determined. Consultation with 3 (0-5)
IT vendors-EHR). Greg Downing and Greg Feero.

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Quality Outcomes
Outcome Objective: Genomics is included content on assessments of quality healthcare
outcomes (i.e., at individual study level, organization, community, national).
Priority
(Target
Strategy Collaborative Partnership
Completion
Years)
Establish genomic critical quality ANA, STTI, AAN, ACMG, NSGC 1 (0-2)
indicators for National Database of
Nursing Quality Indicators
(NDNQI®) program assessment.
AONE, Linda H Aiken, PhD, FAAN, 2 (0-5)
Building on the Genomic Nursing
FRCN, RN Claire M. Fagin Leadership
Science Blueprint identify and
Professor in Nursing, Professor of
standardize critical research indicators
Sociology, and Director of the Center for
(i.e., return on investment for risk
Health Outcomes and Policy Research,
assessment).
University of Pennsylvania
Incentives for the Institution (i.e., ANCC, Joint Commission (JCO) 3 (0-5)
Magnet recognition; L. Aiken’s work
of critical quality indicators and
NDNQI monograph).
Utilize the Aiken’s research model to To be determined. 4 (3-5)
design studies that measure quality
and cost outcomes as a result of using
genomics.

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